The number of total joint
arthroplasties performed in the United States is increasing every year. Owing to the aging population and excellent long-term
prosthesis survival, 45% of patients who undergo joint
arthroplasty will receive two or more joint
arthroplasties during their lifetimes. Periprosthetic joint
infection (PJI) is among the most common complications after
arthroplasty. Evaluation and treatment of PJI in patients with multiple joint
arthroplasties is challenging, and no consensus exists for the optimal management. Multiple PJI can occur simultaneously, synchronous, or separated by extended time, metachronous. Patient risk factors for both scenarios have been reported and may guide evaluation and long-term management. Whether to perform joint aspiration for asymptomatic
prosthesis in the presence of suspected PJI in patients with multiple joint
arthroplasties is controversial. Furthermore, no consensus exists regarding whether patients who have multiple joint
arthroplasties and develop PJI in a single joint should be considered for prolonged
antibiotic prophylaxis to reduce the risk of future
infections. Finally, the optimal treatment of synchronous joint
infections whether by débridement,
antibiotics and implant retention, and one-stage or two-stage revision has not been defined. This review will summarize the best information available and provide pragmatic management strategies.